| NPI | 1538261375 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OR 201706858NP-PP) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OR 201507408RN) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WA AP60776226) | |
| Enumeration Date | 2006-09-02 |
| Last Update Date | 2017-10-02 |